Li Xi-ming, Shao Ming-tao, Wang Jian-juan, Wang Yue-lan
Department of Anesthesiology, Affiliated Qianfoshan Hospital of Shandong University, Jinan 250014, China; Department of Anesthesiology, Linyi City People's Hospital, Linyi 276000, China; Department of Emergency Surgery, Linyi City People's Hospital, Linyi 276000, China; Department of Anesthesiology, Shandong Lunan Ophthalmologic Hospital, Linyi 276000, China.
J Zhejiang Univ Sci B. 2014 Oct;15(10):870-8. doi: 10.1631/jzus.B1400130.
To investigate the relationship between post-operative cognitive dysfunction (POCD) and regional cerebral oxygen saturation (rSO2) and β-amyloid protein (Aβ) in patients undergoing laparoscopic pancreaticoduodenectomy.
Fifty patients undergoing elective laparoscopic pancreaticoduodenectomy received five groups of neuropsychological tests 1 d pre-operatively and 7 d post-operatively, with continuous monitoring of rSO2 intra-operatively. Before anesthesia induction (t0), at the beginning of laparoscopy (t1), and at the time of pneumoperitoneum 120 min (t2), pneumoperitoneum 240 min (t3), pneumoperitoneum 480 min (t4), the end of pneumoperitoneum (t5), and 24 h after surgery, jugular venous blood was drawn respectively for the measurement of Aβ by enzyme-linked immunosorbent assay (ELISA).
Twenty-one cases of the fifty patients suffered from POCD after operation. We found that the maximum percentage drop in rSO2 (rSO(2, %max)) was significantly higher in the POCD group than in the non-POCD group. The rSO(2, %max) value of over 10.2% might be a potential predictor of neurocognitive injury for those patients. In the POCD group, the plasma Aβ levels after 24 h were significantly higher than those of pre-operative values (P<0.01). After 24 h, levels of plasma Aβ in the POCD group were significantly higher than those in the non-POCD group (P<0.01).
The development of POCD in patients undergoing laparoscopic pancreaticoduodenectomy is associated with alterations of rSO2 and Aβ. Monitoring of rSO2 might be useful in the prediction of POCD, and Aβ might be used as a sensitive biochemical marker to predict the occurrence of POCD.
探讨接受腹腔镜胰十二指肠切除术患者的术后认知功能障碍（POCD）与局部脑氧饱和度（rSO2）及β-淀粉样蛋白（Aβ）之间的关系。
50例择期接受腹腔镜胰十二指肠切除术的患者在术前1天和术后7天接受五组神经心理学测试，术中持续监测rSO2。在麻醉诱导前（t0）、腹腔镜开始时（t1）、气腹120分钟时（t2）、气腹240分钟时（t3）、气腹480分钟时（t4）、气腹结束时（t5）及术后24小时，分别采集颈静脉血，采用酶联免疫吸附测定（ELISA）法测定Aβ。
50例患者中有21例术后发生POCD。我们发现，POCD组rSO2的最大百分比下降值（rSO(2, %max)）显著高于非POCD组。rSO(2, %max)值超过10.2%可能是这些患者神经认知损伤的潜在预测指标。在POCD组中，术后24小时血浆Aβ水平显著高于术前值（P<0.01）。术后24小时，POCD组血浆Aβ水平显著高于非POCD组（P<0.01）。
接受腹腔镜胰十二指肠切除术患者的POCD发生与rSO2和Aβ的改变有关。监测rSO2可能有助于预测POCD，Aβ可作为预测POCD发生的敏感生化标志物。
